RESUMO
BACKGROUND Lymphocytic myocarditis (LM) is a rare inflammatory disease of the heart. The clinical presentation of LM varies from mild flu-like symptoms to fulminant myocarditis with cardiogenic shock. Fulminant myocarditis has a poor prognosis and the usual treatment is inotropes with or without ventricular assist devices such as intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (V-A ECMO). We report the case of fulminant LM with severe cardiogenic shock that was successfully treated with concomitant use of IABP and V-A ECMO. CASE REPORT A 32-year-old woman with no medical history presented to the Emergency Department (ED) with chest pain with irradiation to the left upper limb, worse when supine. The electrocardiogram (ECG) on admission showed sinus rhythm with nonspecific ST-T repolarization abnormalities, and laboratory results showed elevated ultrasensitive troponin and C-reactive protein. Transthoracic echocardiography (TTE) showed left ventricular ejection fraction (LVEF) of 25% and diffuse hypokinesis. On the next day, she developed cardiogenic shock requiring vasoactive drugs, IABP, and V-A ECMO. Pulse therapy with methylprednisolone was started. Endomyocardial biopsy (EMB) revealed acute LM, and intravenous human immunoglobulin was administered. The patient evolved with progressive clinical improvement, being discharged 56 days after admission, with an improvement in the LVEF to 55%. CONCLUSIONS Fulminant LM is a rare and potentially fatal condition that requires immediate intervention. The combination of IABP and V-A ECMO among patients with LM-cardiogenic shock may provide survival benefits.
Assuntos
Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Miocardite , Adulto , Feminino , Humanos , Oxigenação por Membrana Extracorpórea/métodos , Miocardite/complicações , Miocardite/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Acinetobacter baumannii, a common pathogen in nosocomial infections, is a rare cause of community-acquired pneumonia. This report highlights the difficulties in its early diagnosis and effective treatment, as it is a multidrug-resistant microorganism with rapid, unfavorable progression. To better understand its clinical outcome, we searched the literature for similar cases but found no community-acquired cases in Brazil.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Infecções Comunitárias Adquiridas , Pneumonia , Humanos , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Brasil , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológicoRESUMO
ABSTRACT Acinetobacter baumannii, a common pathogen in nosocomial infections, is a rare cause of community-acquired pneumonia. This report highlights the difficulties in its early diagnosis and effective treatment, as it is a multidrug-resistant microorganism with rapid, unfavorable progression. To better understand its clinical outcome, we searched the literature for similar cases but found no community-acquired cases in Brazil.